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February 9, 2017
Subject: The Emperor Of non-fiction scientific books is here
Subject: The Emperor Of non-fiction scientific books is here
The Einstein Journal of Biology and Medicine 41
The Emperor of All Maladies: A Biography of Cancer
Christopher Beaudoin, BA
Albert Einstein College of ... Medicine, Bronx, NY 10461.
As both a medical student and a cancer patient,
I found that the Pulitzer Prize–winning book
The Emperor of All Maladies: A Biography of
Cancer by Siddhartha Mukherjee, D.Phil., MD
(Simon and Schuster, 2010), gave me at once a dose of
knowledge and a salve for the soul. Early in the book,
Dr. Mukherjee candidly writes that he started his biography
of cancer as a way, ironically, to escape his “immersive”—read
“drowning”—oncology fellowship. He fled
into the annals of cancer-treatment research to make
sense of the lethal complexity—scientific, emotional,
and human—that he and his patients were experiencing.
He addresses the questions anyone with cancer can
bat away only for so long: What is cancer? Why me?
Years later, the finished product, a magisterial work of
enormous research and reflection on the nature of cancer,
has won and deserved its shower of accolades.
For Mukherjee, the modern history of cancer begins
with Sidney Farber (of the eponymous Dana-Farber
Cancer Institute, where Mukherjee received fellowship
training), who warrants a book all his own. In the 1950s,
Farber, a pathologist by training, became dissatisfied
with the cloistered world of the lab and began his quixotic
search for the cure for childhood leukemia, and more
broadly, cancer itself. Taking a page from Paul Ehrlich’s
Salvarsan, a drug developed for syphilis decades earlier
and the first “chemotherapy,” or sought-after “magic
bullet,” Farber dreamed of treating cancer not with the
scalpel or the X-ray beam but with a drug, something
that was then inconceivable, cancer being more or less
a black box of biology at the time. This turned out to be
a prescient dream, as Farber’s therapeutic application of
“fake vitamins” such as aminopterin and its sister acid,
methotrexate, allowed him to leapfrog ahead of the
contemporary understanding of cancer’s mechanics to
produce remissions, even cures, among a few of his first
otherwise tragic cohort of children.
The first chapters introduce a cast of memorable characters.
Mukherjee carefully marks pivotal moments in the
history of medicine that shed light on cancer’s mystery
for us; these chapters are enjoyable enough for newbies
and will be relished by the well initiated. They are signposts
indicating entrance to a new and foreign land: we
are introduced to Vesalius’ anatomical revolution, challenging
dogma by mapping the human body and ultimately
unseating the vague theory of “black humours”
Galen ascribed to cancer’s root; the discovery of the
Rous sarcoma virus, which causes cancer in chickens,
thus establishing a viral theory of carcinogenesis; the
first case-control study by Hill and Doll, a maneuver to
convince a circumspect medical community that smoking
played a role in lung cancer; and the first randomized
clinical trial to establish streptomycin as an effective
treatment for tuberculosis and the pioneering cancer trials
that quickly followed. Finally, Mukherjee includes the
early days of HIV and the rabid advocacy it inspired (see,
for example, the play The Normal Heart, which won a
Tony in 2011). The sword cuts both ways here; scientists
were saving lives by accelerating access to experimental
treatments, but also setting—and years later springing—
the trap for quackery on an international scale (see Dr.
Werner Bezwoda).
For a book aimed at relating the enormous intellectual
challenge that cancer presents to scientists and laypeople
alike, its writing retains enormous heart. The passages
about patients are so personal and poignant that
you are apt to wonder what was the last nonfiction book
you read that provoked such an emotional response—
and at the clip of a Tom Clancy thriller. The book is in
some respects a coming-of-age story, a bildungsroman
of cancer culled from an assortment of vignettes and
research (there are abundant epigrams for each chapter),
as cancer becomes, as Mukherjee eloquently puts
it, “the quintessential illness of modernity,” noting that
it was only recently unveiled by advances in science,
hygiene, and longevity. Dr. Mukherjee lionizes patients
who found themselves at turning points in the history
of cancer, such as little “Jimmy” (his real name—Einar
Gustafson—too unwieldy for a 1950s American public)
of the Jimmy Fund, and Barbara Bradfield, who had
resigned herself to cancer’s rapidly progressing, lethal
endgame by retiring to Mexico before being handpicked
to be the first to receive targeted cancer therapy using
antibodies. Also compelling is the ripe-for-Hollywood
tale of the young, crusading scientist Dr. Druker, with
the cure for chronic myelogenous leukemia lying on a
counter in his lab—the “magic bullet” that Ehrlich had
augured almost a hundred years before—who must
strong-arm the reluctant pharmaceutical company into
production of what would become the wonder drug
Gleevec, which exceeded $1 billion in revenue last year.
Long periods of darkness, of course, overshadow these
blips of success. The history of cancer treatment has, by
and large, been a long, sad, and mostly failing story. The
earliest reference to cancer, in 1600 B.C., by the Egyptian
physician Imohtep, sums up the patient’s fate grimly:
“For this, there is no treatment.” This terse statement
effectively became the standard of care for the next few
millennia. With advances in surgery at the end of the
1800s, cancer treatment underwent a reappraisal. One
ambitious surgeon, Dr. William Halsted—perhaps the
book’s villain, if a human and tragic one—pioneered the
most aggressive surgical treatment for breast cancer, the
radical mastectomy. While improved surgical techniques
4BOOK REVIEW
42 EJBM, Copyright © 2012
The Emperor of All Maladies: A Biography of Cancer
provided an inroad to treating these tumors, Halsted’s
extreme technique turned out to be more disfiguring
than therapeutic, and when he was faced with evidence
of that, he deluded himself and retreated into alternating
heroin and cocaine addictions.
Dr. Mukherjee’s experience in the wards provides a handful
of cameos, not only presenting him as a sort of Virgil
to cancer’s Inferno, describing the many hellish treatments
that were used during the evolution of oncology,
but also as a father, at the birth of his first child, and as a
fellow, with vignettes of his own from the wards. These
experiences set an expansive stage where cancer plays its
role as antagonist and protagonist throughout ancient
and modern medical history.
Mukherjee saves his best device for last, moving through
the centuries with the story of Atossa, a Persian queen
from 300 B.C. with breast cancer, as “cancer’s Dorian
Grey,” following the progression of treatment from
her own time (essentially, a brutal mastectomy) to the
care she would have received in Halsted’s day, also radical
and disfiguring, to the treatment she would receive
today: evidence-based surgical techniques, radiation,
hormone and targeted therapy, along with a battery
of screening measures based on her ethnic background
and age, aimed at early detection and intervention for
BRCA mutations. He also muses on a tantalizing future
of individual patients’ sequenced cancer genomes on
flash drives, put into algorithms and matched to customized
treatment regimens. But Mukherjee tempers
his optimism, pointing out that with some kinds of cancer,
such as pancreatic, the improved survival is measured
in months, scarcely enough time for the requisite
bookkeeping of our modern lives before we shuffle off
the mortal coil. “Onkos (for oncology) arises from the
ancient word nek,” Mukherjee writes at the book’s conclusion,
which means “to carry, to move the burden from
one place to the next, to bear something across a long
distance and bring it to a new place. It is an image that
captures not just the cancer cell’s capacity to travel—
metastasis—but also Atossa’s journey, the long arc of
scientific discovery—and embedded in that journey, the
animus, so inextricably human, to outwit, to outlive,
and survive.” By the end, Mukherjee has done more
than simply tell the story of cancer; he has identified the
struggle against cancer as something profoundly human
and dignified and timeless, if no less tragic.
Corresponding Author: Christopher Beaudoin, BA (christopher.beaudoin@
med.einstein.yu.edu).
Conflict of Interest Disclosures: The author has completed and submitted the
ICMJE Form for Disclosure of Potential Conflicts of Interest. No conflicts were
noted.
4BOOK REVIEW
The Emperor of All Maladies: A Biography of Cancer
Christopher Beaudoin, BA
Albert Einstein College of ... Medicine, Bronx, NY 10461.
As both a medical student and a cancer patient,
I found that the Pulitzer Prize–winning book
The Emperor of All Maladies: A Biography of
Cancer by Siddhartha Mukherjee, D.Phil., MD
(Simon and Schuster, 2010), gave me at once a dose of
knowledge and a salve for the soul. Early in the book,
Dr. Mukherjee candidly writes that he started his biography
of cancer as a way, ironically, to escape his “immersive”—read
“drowning”—oncology fellowship. He fled
into the annals of cancer-treatment research to make
sense of the lethal complexity—scientific, emotional,
and human—that he and his patients were experiencing.
He addresses the questions anyone with cancer can
bat away only for so long: What is cancer? Why me?
Years later, the finished product, a magisterial work of
enormous research and reflection on the nature of cancer,
has won and deserved its shower of accolades.
For Mukherjee, the modern history of cancer begins
with Sidney Farber (of the eponymous Dana-Farber
Cancer Institute, where Mukherjee received fellowship
training), who warrants a book all his own. In the 1950s,
Farber, a pathologist by training, became dissatisfied
with the cloistered world of the lab and began his quixotic
search for the cure for childhood leukemia, and more
broadly, cancer itself. Taking a page from Paul Ehrlich’s
Salvarsan, a drug developed for syphilis decades earlier
and the first “chemotherapy,” or sought-after “magic
bullet,” Farber dreamed of treating cancer not with the
scalpel or the X-ray beam but with a drug, something
that was then inconceivable, cancer being more or less
a black box of biology at the time. This turned out to be
a prescient dream, as Farber’s therapeutic application of
“fake vitamins” such as aminopterin and its sister acid,
methotrexate, allowed him to leapfrog ahead of the
contemporary understanding of cancer’s mechanics to
produce remissions, even cures, among a few of his first
otherwise tragic cohort of children.
The first chapters introduce a cast of memorable characters.
Mukherjee carefully marks pivotal moments in the
history of medicine that shed light on cancer’s mystery
for us; these chapters are enjoyable enough for newbies
and will be relished by the well initiated. They are signposts
indicating entrance to a new and foreign land: we
are introduced to Vesalius’ anatomical revolution, challenging
dogma by mapping the human body and ultimately
unseating the vague theory of “black humours”
Galen ascribed to cancer’s root; the discovery of the
Rous sarcoma virus, which causes cancer in chickens,
thus establishing a viral theory of carcinogenesis; the
first case-control study by Hill and Doll, a maneuver to
convince a circumspect medical community that smoking
played a role in lung cancer; and the first randomized
clinical trial to establish streptomycin as an effective
treatment for tuberculosis and the pioneering cancer trials
that quickly followed. Finally, Mukherjee includes the
early days of HIV and the rabid advocacy it inspired (see,
for example, the play The Normal Heart, which won a
Tony in 2011). The sword cuts both ways here; scientists
were saving lives by accelerating access to experimental
treatments, but also setting—and years later springing—
the trap for quackery on an international scale (see Dr.
Werner Bezwoda).
For a book aimed at relating the enormous intellectual
challenge that cancer presents to scientists and laypeople
alike, its writing retains enormous heart. The passages
about patients are so personal and poignant that
you are apt to wonder what was the last nonfiction book
you read that provoked such an emotional response—
and at the clip of a Tom Clancy thriller. The book is in
some respects a coming-of-age story, a bildungsroman
of cancer culled from an assortment of vignettes and
research (there are abundant epigrams for each chapter),
as cancer becomes, as Mukherjee eloquently puts
it, “the quintessential illness of modernity,” noting that
it was only recently unveiled by advances in science,
hygiene, and longevity. Dr. Mukherjee lionizes patients
who found themselves at turning points in the history
of cancer, such as little “Jimmy” (his real name—Einar
Gustafson—too unwieldy for a 1950s American public)
of the Jimmy Fund, and Barbara Bradfield, who had
resigned herself to cancer’s rapidly progressing, lethal
endgame by retiring to Mexico before being handpicked
to be the first to receive targeted cancer therapy using
antibodies. Also compelling is the ripe-for-Hollywood
tale of the young, crusading scientist Dr. Druker, with
the cure for chronic myelogenous leukemia lying on a
counter in his lab—the “magic bullet” that Ehrlich had
augured almost a hundred years before—who must
strong-arm the reluctant pharmaceutical company into
production of what would become the wonder drug
Gleevec, which exceeded $1 billion in revenue last year.
Long periods of darkness, of course, overshadow these
blips of success. The history of cancer treatment has, by
and large, been a long, sad, and mostly failing story. The
earliest reference to cancer, in 1600 B.C., by the Egyptian
physician Imohtep, sums up the patient’s fate grimly:
“For this, there is no treatment.” This terse statement
effectively became the standard of care for the next few
millennia. With advances in surgery at the end of the
1800s, cancer treatment underwent a reappraisal. One
ambitious surgeon, Dr. William Halsted—perhaps the
book’s villain, if a human and tragic one—pioneered the
most aggressive surgical treatment for breast cancer, the
radical mastectomy. While improved surgical techniques
4BOOK REVIEW
42 EJBM, Copyright © 2012
The Emperor of All Maladies: A Biography of Cancer
provided an inroad to treating these tumors, Halsted’s
extreme technique turned out to be more disfiguring
than therapeutic, and when he was faced with evidence
of that, he deluded himself and retreated into alternating
heroin and cocaine addictions.
Dr. Mukherjee’s experience in the wards provides a handful
of cameos, not only presenting him as a sort of Virgil
to cancer’s Inferno, describing the many hellish treatments
that were used during the evolution of oncology,
but also as a father, at the birth of his first child, and as a
fellow, with vignettes of his own from the wards. These
experiences set an expansive stage where cancer plays its
role as antagonist and protagonist throughout ancient
and modern medical history.
Mukherjee saves his best device for last, moving through
the centuries with the story of Atossa, a Persian queen
from 300 B.C. with breast cancer, as “cancer’s Dorian
Grey,” following the progression of treatment from
her own time (essentially, a brutal mastectomy) to the
care she would have received in Halsted’s day, also radical
and disfiguring, to the treatment she would receive
today: evidence-based surgical techniques, radiation,
hormone and targeted therapy, along with a battery
of screening measures based on her ethnic background
and age, aimed at early detection and intervention for
BRCA mutations. He also muses on a tantalizing future
of individual patients’ sequenced cancer genomes on
flash drives, put into algorithms and matched to customized
treatment regimens. But Mukherjee tempers
his optimism, pointing out that with some kinds of cancer,
such as pancreatic, the improved survival is measured
in months, scarcely enough time for the requisite
bookkeeping of our modern lives before we shuffle off
the mortal coil. “Onkos (for oncology) arises from the
ancient word nek,” Mukherjee writes at the book’s conclusion,
which means “to carry, to move the burden from
one place to the next, to bear something across a long
distance and bring it to a new place. It is an image that
captures not just the cancer cell’s capacity to travel—
metastasis—but also Atossa’s journey, the long arc of
scientific discovery—and embedded in that journey, the
animus, so inextricably human, to outwit, to outlive,
and survive.” By the end, Mukherjee has done more
than simply tell the story of cancer; he has identified the
struggle against cancer as something profoundly human
and dignified and timeless, if no less tragic.
Corresponding Author: Christopher Beaudoin, BA (christopher.beaudoin@
med.einstein.yu.edu).
Conflict of Interest Disclosures: The author has completed and submitted the
ICMJE Form for Disclosure of Potential Conflicts of Interest. No conflicts were
noted.
4BOOK REVIEW
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